SGIM Forum

Perspective: Part I

Frontliners International: A Global Pandemic and the Race to Vaccinate

Ms. Dubrow (dubrowm@sgim.org) is the member engagement associate at the Society of General Internal Medicine. Dr. Khoo (chingsoongkhoo@gmail.com) is a lecturer and consultant neurologist from the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia. Dr. Liakou (liakou@gmail.com) is an attending physician in internal medicine at Athens Medical Practice in Athens, Greece. Dr. Majeed (shin-mat@nifty.com) is the head of the Department of Primary Care and Public Health at Imperial College London, United Kingdom.

A year into the COVID-19 pandemic, the world is only just beginning to see true containment of the virus in sight. In a previous Frontliners International article, the pandemic was still in its first few months, but fears for a larger second wave were apparent in countries across Europe, Asia, and the Americas. Now, with vaccination drives in their early stages in many countries, there is optimism around the vaccines’ effectiveness. As of March 24, 2021, the official figures stand at 124.95 million cases and 2.75 million deaths globally. However, a new statistic has entered the COVID-19 discourse: vaccination rates: More than 476 million vaccines (either first or second dose) have been administered across 111 countries.1 While the number vaccinated continues to climb, the number of cases shows no signs of slowing—yet. SGIM spoke with three of our international members to reflect on the COVID-19 pandemic and what their vaccine roll-out plans look like.

What were your countries’ initial policies to curb the spread of COVID-19?

Dr. Khoo: A Movement Control Order (MCO) under the Prevention and Control of Infectious Diseases Act 1988 and the Police Act 1967 was promulgated starting on March 18, 2020, in Malaysia to mitigate the spread of COVID-19. Mass gatherings were strictly prohibited. Most businesses were shut down except stores providing necessities. Malaysians were not permitted to travel abroad. For those returning from overseas, a 14-day self-quarantine was required. Schools, colleges, and universities were closed. Only essential services were permitted to continue operating.

Dr. Liakou: Very early during the pandemic, Greece had a crisis management team led by the prime minister. Members were physicians, economists, healthcare executives, and media experts. The lockdown was early, strict, and long. The country acted fast to begin cancelling large gatherings. The government banned all non-essential travel starting March 23, 2020. Standardized consequences for lockdown violators included strict and severe penalties, such as a €150 fine for individuals who did not follow lockdown measures.

Dr. Majeed: Initially, traditional methods of outbreak control were used: testing of suspected cases, contact tracing, and quarantine of suspected cases whilst awaiting test results. However, the public health system in the U.K. was soon overwhelmed by the speed and scale of the COVID-19 pandemic. Community testing and contact tracing were largely abandoned in March 2020. This led to a rapid increase in the number of cases, imposing significant strain on the health system and resulting in the U.K. having one of the world’s highest infection and mortality rates from COVID-19.

How did the winter months and holiday season impact the number of COVID-19 cases in your country?

Dr. Khoo: We started seeing an upsurge in COVID-19 cases since October 2020 with approximately 3,000 new cases being detected daily. As of February 2021, we are in the third wave of the COVID-19 pandemic. The case fatalities are creeping up and the death toll [continues to climb] as of March 2021.

Dr. Liakou: At the beginning of November 2020, Greece experienced an acute increase of the COVID-19 cases [so] we entered a new lockdown that stopped at the end of January 2021. Therefore, we did not have any other public health emergencies during holidays. Schools were 100% on tele-education and all private and public companies on 70% mandatory teleworking. Shopping, restaurants, bars are still on lockdown (as of February 4, 2021). There were strict regulations that only six people from the same family could gather during Christmas and New Year’s days. Additionally, there was a strong recommendation for these gatherings to involve the same people on both days.

Dr. Majeed: During the winter of 2020 and the holiday season, we saw a large increase in the number of Covid-19 cases in the U.K., with more than 50,000 new cases on many days. Pressures on the National Health Service also increased with a large increase in the number of hospital admissions during December 2020 and January 2021.

What factors (social, political, cultural, or otherwise) do you attribute to the success or failing of your country’s response to COVID-19?

Dr. Khoo: Regardless of ethnicity, religion, or political affiliation, numerous organizations and companies work selflessly to optimize the PPE supply for the frontline workers. Fundraising events help provide medical personnel with the necessities. Frontline workers are constantly thanked for their sacrifices and dedication. We are thankful to Dr. Noor Hisham Abdullah (Director-General of Health) for his outstanding leadership in handling the pandemic in Malaysia.

Dr. Liakou: In Greece, the strong feeling of community and family values kept the patients and society safe early in the pandemic with a manageable 20-25 new cases daily. Even during the Christmas period, people followed strict lockdown with only 6 people able to gather from the same family.

Dr. Majeed: The U.K. is highly urbanized with many travelers to and from the country. This resulted in COVID-19 rapidly spreading across the U.K., overwhelming the public health infrastructure. In England, reductions in public health budgets in 2013 and consequent departure of, many highly experienced, medically qualified public health specialists weakened the public health infrastructure, including services for infectious disease control. A lack of COVID-19 testing capacity meant that people with COVID-19 did not get a test early in the pandemic when infection rates were the highest. Finally, for ideological reasons, the government relied heavily on commercial companies to implement its public health response (testing and contact tracing), rather than building on the existing infrastructure in the National Health Service (NHS) and local government.

Does your country currently have access to any of the COVID-19 vaccines, and if so, what is roll-out plan?

Dr. Khoo: The COVID-19 vaccines are estimated to be available in our country in the first quarter of the year. An agreement has been finalized to purchase the vaccines from Pfizer. A vaccination priority list has been created to protect the most vulnerable people, frontline workers from the healthcare and security sectors and then senior citizens 60 years and above and those with chronic diseases.

Dr. Liakou: We have access to the Pfizer and Moderna vaccines. Healthcare workers and those 85+ get the first doses. We started vaccinations on January 9, 2021 and 140,000 people have received the first dose of vaccine. Vaccination centers are located throughout the cities on public and private hospitals.

Dr. Majeed: The U.K. began its COVID-19 vaccination program on December 8, 2020, with the Pfizer vaccine. In January 2021, the AstraZeneca vaccine also began to be used. The Moderna vaccine is also approved for use in the U.K. The U.K. is currently ranked fourth in the world for the number of vaccine doses administered per person. Vaccines are delivered from a range of sites, including hospitals, general practices, pharmacies, and large vaccination hubs.

What do you perceive as the biggest challenge to getting your country’s population vaccinated?

Dr. Khoo: Vaccine hesitancy. Not only does this happen to the new COVID-19 vaccines, but also occurs in our existing vaccines. Moreover, we do not know exactly if these new vaccines will be able to protect the people from severe infections. There is no skimping on the long-term safety data.

Dr. Liakou: I am not sure if we will have enough doses to vaccinate. Production is not adequate as of March 2021.

Dr. Majeed: The biggest challenge currently is a lack of vaccines as of March 2021. The NHS has considerably more capacity to vaccinate than it has vaccines. In the longer term, vaccine hesitancy will be a key issue, particularly once the U.K. starts vaccinating younger people.

Have you received the vaccine as of March 2021, and if so, what was your experience?

Dr. Khoo:  I have not yet.

Dr. Liakou: I received the first dose. I developed a minor topical reaction on my arm for two days, and some myalgias for three to four days. Nothing serious, I am looking forward to the second dose!

Dr. Majeed: I have received my first dose of Pfizer vaccine from a local hospital vaccine clinic. I had some mild side effects (sore arm, tiredness) that resolved in 2-3 days. I am awaiting my second dose as the U.K. government has decided to delay second doses of the Pfizer vaccine to 12 weeks compared to the usual 3 weeks.

Closing

As the pandemic continues into its second year, there is a sense of hope that the end of COVID-19 is finally near. Numerous vaccines have been approved for use, vaccination plans are being enacted around the world, and the hunger for a return to normalcy may finally be abated. However, vaccine hesitancy and a lack of vaccine access for many around the world may slow the decrease in COVID-19 cases. Around the world, SGIM members are aware of the challenges of the vaccination roll-out plans, but like us all, they are hopeful for a future in which the world is not controlled by the COVID-19 pandemic.

References

  1. More than 468 million shots given: Covid-19 Tracker. Bloomberg. https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/. Accessed March 24, 2021.

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